The purposes of this project are to continue to evaluate trends in infant sleep practices and adoption of the American Academy of Pediatrics' and the Public Health Service's Back to Sleep recommendations to reduce the risk of Sudden Infant Death Syndrome (SIDS), and to expand on current studies with a new study that examines in greater depth the factors influencing these trends and the racial disparity in adoption of safe sleep practices. The NISP telephone survey, an annual telephone survey of approximately 1,000 U.S. caregivers of infants <8 months of age carried out since 1992, will be continued for 2 additional years, and then be transitioned to a newly developed Survey to Assess Factors Effecting (SAFE) Infant Sleep Practices. The new survey technique involves the recruitment of a nationally representative sample of 1000 new mothers annually from 32 randomly selected U.S. maternity hospitals with an in-depth 2-4 month follow-up survey; the sampling design also includes an oversampling of African-Americans, who traditionally have had lower adherence to safe sleep recommendations and higher rates of SIDS. The SAFE study will survey mothers about infant care practices that influence SIDS risk, including sleep position, bed sharing, and pacifier use. Not only will this approach result in a national probability sample of new mothers, it will also provide a sufficiently large sample of African-American mothers for separate analysis. The newly designed survey, based on the Theory of Planned Behavior, will institute specific methodologies designed to illuminate risk factors for non-adherence, particularly in the vulnerable socioeconomic and minority populations. With this approach, we will: 1) evaluate national trends, and trends within specific vulnerable populations, with regard to recommended infant sleep practices (supine sleep position, non-bed sharing, and use of pacifier); and 2) ascertain determinants of caregivers' intentions and practices in relation to safe sleep recommendations. RELEVANCE: Since SIDS is the most common cause of infant mortality beyond the neonatal period, and adherence to safe infant sleep practices has been proven to reduce the risk of SIDS, understanding the reasons for nonadherence to infant sleep recommendations, especially among minority and other vulnerable populations who have the highest rates of SIDS, is a national public health priority.